Organization
COWAN PHARMACY LLC
Active
Other names
Conyers Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM MITCHAM (PRESIDENT)
(770) 929-1414
Entity
Organization
Contact information
Practice address
1179 WEST AVE SW, CONYERS, GA 30012-5280
(770) 929-1414
(770) 929-3002
Mailing address
1179 WEST AVE SW, CONYERS, GA 30012-5280
(770) 929-1414
(770) 929-3002
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010400
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003202657A
—
GA
01
—
2177325
PK
—
Enumeration date
08/04/2006
Last updated
07/19/2018
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